Scoliosis surgery, particularly in adolescent idiopathic scoliosis, necessitates careful anesthetic management to optimize surgical outcomes and minimize neurophysiological compromise. Neurophysiological compromise refers to the potential disruption of somatosensory-evoked potentials (SSEPs) and motor-evoked potentials (MEPs) during surgery, which are critical indicators of spinal cord integrity. Preserving these signals is essential to reduce the risk of intraoperative neurological injury, such as motor or sensory deficits. This narrative review presents current anesthetic techniques, focusing on Total Intravenous Anesthesia (TIVA) and inhalational methods and their implications for intraoperative neurophysiological monitoring and postoperative recovery. TIVA, utilizing agents like propofol and remifentanil, has emerged as a preferred approach due to its favourable pharmacodynamics, resulting in less suppression of SSEPs and MEPs than inhalational agents. The review highlights the potential of adjuncts, including dexmedetomidine and low-dose ketamine, in enhancing analgesia and mitigating opioid-related side effects. Furthermore, the erector spinae plane (ESP) block is discussed as an innovative regional technique that may improve postoperative pain control while reducing systemic opioid requirements. Emphasizing a multimodal analgesic strategy, the review underscores the importance of integrating various pharmacological and non-pharmacological approaches to optimize postoperative pain management. Ongoing research is vital for refining anesthetic protocols and enhancing patient outcomes in scoliosis surgery, ultimately ensuring the safety and efficacy of these complex procedures.